|
I. Digitally signed by Francine R.
<br />_ Francine R. Villareal Villareal
<br />MMIDDIY
<br />AI CERTIFICATE OF LIABILITY INSURANCE °AT„,zozlYYYl
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />CONTACT
<br />NAME: Kim Tran
<br />P"°NE 616.53s.asla aC No: 818.539.8617
<br />E-MAIL
<br />ADOREss: kim tran a' ,com
<br />Glendale CA91203
<br />INSLIFUI AFFORDING COVERAGE
<br />NAICIf
<br />INSURER A: Insurance Company of the West
<br />27847
<br />License#: 0726293
<br />INSURED COMMACT-20
<br />Community Action Partnership of Orange County
<br />11870 Monarch Street
<br />INSURER B: Nonprofits' Insurance Alliance of CA
<br />INSURERC:
<br />NSURER D:
<br />Garden Grove, CA 92841
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 989075818 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD ADDL
<br />SUSRVIVO
<br />POLICY NUMBER
<br />MMIUDYNYV(
<br />MMIDONYYV
<br />LIMITS
<br />e
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />Y
<br />2021-00441
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIM&MADE 1XI OCCUR
<br />AMAGE TO RENTED
<br />PREM SES (Ee occu once)
<br />$ 600,000
<br />MED EXP (Any one IF arson)
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$1.000,000
<br />GENT
<br />AGGREGATE U MIT APPLIES PER:
<br />G EN ERA- AGGREGATE
<br />$3, 000,000
<br />X
<br />POLICY JET LOC
<br />PRODUCTS - COMP/OP AGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-00441
<br />7/1/2021
<br />7/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ee rdeddenl
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />IX
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />2021-00441-UMB
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMB-MADE
<br />DED I X I RETENTION$ I
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />VINE 505610701
<br />7/1/2021
<br />7/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETORIPARTNEWEXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICERIMEMBER EXCLUDED4 ❑
<br />NIA
<br />E. L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yas, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />B
<br />Director&Officers
<br />2021-00441-DO-NPO
<br />7/1/2021
<br />7/l/2022
<br />Each Wrongful Act
<br />$1,000,000
<br />Aggreggate Limit
<br />Retenilon
<br />$2,000,000
<br />$5,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD101,Addlllonal Remarks Schetlule, may be attached if more space is required)
<br />Nonprofits' Insurance Alliance of CA - A.M. Best #: 011845
<br />Policy: Impproper Sexual Conduct
<br />Policy#: 2021-00441
<br />Policy term: 7/1/2021 to 7/1/2022
<br />Carrier: Nonprofits' Insurance Alliance of CA
<br />Per Claim: $1,000,000, Aggregate Limit: $3,000,000
<br />See Attached...
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza,
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />©1988-2015 ACORD C
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />rwu ,, lUsk&MAnaganenCDMeNn
<br />8I REVIEWED&APPRovBJ BY:
<br />RISK W illageme0tAnalyst
<br />
|